Advanced Extubation Strategy in a Pediatric Difficult Airway: Successful Use of a Cook Staged Extubation Set

We report the case of a 14-year-old girl with a large cervical venous malformation extending to the pharyngeal mucosa who underwent sclerotherapy with bleomycin and polidocanol. Given the risk of airway obstruction and bleeding, awake fiberoptic intubation was performed under sedation with ketamine and dexmedetomidine. Extubation was deferred until postoperative day 6 due to persistent edema and residual malformation. A staged extubation strategy using a Cook Staged Extubation Set (CSES) (Cook Medical, Bloomington, IN, USA) was selected to ensure safe airway control. The device was well tolerated for 12 hours without complications or the need for reintubation. To our knowledge, this is the first reported pediatric case describing the successful use of a CSES for planned extubation of an anatomically difficult airway. This case underscores the importance of individualized extubation planning and multidisciplinary collaboration in pediatric airway management.